An external breast prosthesis, or breast form, is a medical device worn against the body to recreate the shape of a breast after surgery. Typically made from soft materials, the form mimics the weight and feel of natural breast tissue. The primary purpose is to restore physical symmetry and balance, which helps correct posture and prevent back, neck, or shoulder strain resulting from uneven weight distribution. A properly fitted prosthesis also ensures that clothing hangs correctly, helping individuals regain confidence after a mastectomy or lumpectomy.
Understanding Prosthesis Types and Selection
Prostheses are manufactured from different materials, offering unique benefits depending on the user’s stage of recovery and daily activities. Temporary forms are often constructed from lightweight foam, fiberfill, or soft fabric and are used immediately following surgery while the incision site is healing. These soft forms are lighter and cooler, making them suitable for initial post-operative wear or for use during exercise and sleep.
Permanent forms are typically made of medical-grade silicone gel encased in a durable film, which offers a weight and movement similar to a natural breast. The weight of a silicone prosthesis is particularly relevant for individuals who have had a unilateral mastectomy, as it helps balance the torso and prevent the spine from curving toward the heavier side. Manufacturers also offer lightweight silicone forms for those who have had bilateral surgery or who prefer less weight against their chest wall.
The attachment method falls into two categories: non-adhesive and adhesive forms. Non-adhesive forms fit securely within the pocket of a specialized mastectomy bra, providing support without direct skin contact. Conversely, adhesive forms use a silicone backing that sticks directly to the chest wall, distributing weight over a larger area and staying in place without a pocketed bra. The choice often depends on the user’s preference for wearing regular bras and the sensitivity of their skin or scar tissue.
Prostheses come in various shapes. Symmetrical forms (oval or triangular) are used for a full mastectomy, while asymmetrical forms (with extensions) accommodate surgery that removed tissue up into the underarm or collarbone area. Partial forms, sometimes called shapers or shells, are available for individuals who have had a lumpectomy or breast-conserving surgery and need to fill in a small section of missing tissue. A professional fitting is essential to match the form’s contour and projection to the remaining breast and the individual’s body shape.
Locating Certified Fitters and Suppliers
Obtaining a proper fit requires the guidance of a Certified Mastectomy Fitter (CMF), a healthcare professional trained in the provision of external breast prostheses and related garments. CMFs have specialized knowledge of surgical procedures, product technologies, and the musculoskeletal impact of uneven weight distribution. This expertise ensures the selected form provides physical balance and a natural appearance under clothing.
Fitting Locations
Fittings are typically conducted in a private setting at several types of locations: specialty mastectomy boutiques, hospital-affiliated cancer centers, and Durable Medical Equipment (DME) suppliers. Specialty boutiques often provide a wide range of products and personalized attention in a comfortable, non-clinical atmosphere. Hospital programs may be convenient for those already receiving care at the facility. DME suppliers are often focused on maximizing insurance coverage for medical devices.
The fitting process usually takes place about six to eight weeks after surgery, once the surgical site is fully healed and any swelling has subsided. The CMF begins by assessing the healed incision and taking precise measurements of the chest wall and the remaining breast, if applicable, to determine the correct bra size. They then recommend a series of prosthesis shapes, weights, and sizes for the individual to try on with a pocketed bra.
During the appointment, the fitter observes the prosthesis under a light-colored, fitted shirt to ensure symmetry and a natural drape of the clothing. The goal is to find a form that feels comfortable, remains stationary during movement, and accurately matches the size and shape of the remaining breast. The CMF also provides instructions on the care and maintenance of the prosthesis and specialized bra, and manages the necessary insurance paperwork.
Navigating Insurance and Coverage
Insurance coverage for external breast prostheses is governed by federal law and medical necessity guidelines. Under the Women’s Health and Cancer Rights Act (WHCRA), group health plans covering mastectomies must also cover external prostheses, mastectomy bras, and treatment for physical complications like lymphedema. This mandate ensures coverage is provided whether an individual uses a prosthesis instead of, or in addition to, breast reconstruction surgery.
To initiate coverage, a physician’s prescription or order is necessary. This order should clearly state the diagnosis and specify the affected side, such as “left external breast prosthesis and mastectomy bra,” establishing medical necessity. While WHCRA mandates coverage, most private plans apply standard deductibles, copayments, and coinsurance to the cost of the prosthesis, meaning out-of-pocket expenses are common.
Medicare Part B covers external breast prostheses and related supplies as prosthetic devices, provided they are prescribed by a doctor. Medicare typically covers one new silicone prosthesis every two years, or a foam/fiberfill form every six months, for each affected side. After meeting the Part B deductible, the beneficiary is responsible for 20% of the Medicare-approved cost.
Coverage for mastectomy bras, which are necessary to hold the external form, is common across most insurance plans. Medicare generally covers the replacement of mastectomy bras as needed. Many private insurers, however, limit coverage to a specific number, such as two to six bras, per year. It is recommended to contact the insurance carrier directly to verify specific plan limitations and confirm whether a supplier is in-network to minimize costs.